insulin lispro (Humalog, Humalog Kwikpen)
Classes: Antidiabetics, Insulins; Antidiabetics, Rapid-Acting Insulins
Dosing and uses of Humalog, HumaPen Memoir (insulin lispro)
Adult dosage forms and strengths
injectable solution
- 100units/mL (10mL vial)
injectable pen
- 100units/mL (3mL pen or cartridge)
- 200units/mL (3mL pen or cartridge)
Type 1 or 2 Diabetes Mellitus
Rapid-acting human insulin analogue indicated to improve glycemic control in adults and children with type 1 or 2 diabetes mellitus
Type 1 diabetes mellitus
- Approximately one third of the total daily insulin requirements SC; rapid-acting or short-acting, premeal insulin should be used to satisfy the remainder of the daily insulin requirements
- Usual daily maintenance range is 0.5-1 unit/kg/day in divided doses; nonobese may require 0.4-0.6 unit/kg/day; obese may require 0.8-1.2 units/kg/day
Type 2 diabetes mellitus
- Type 2 diabetes mellitus inadequately controlled with oral medication
- 10 units/day SC (or 0.1-0.2 unit/kg/day) of intermediate- or long-acting insulin given at bedtime generally recommended; as an alternative, rapid-acting formulations, such as insulin lispro, given before meals have also been used; dose must be adjusted carefully.
Dosing Considerations
When given subcutaneously, insulin lispro has a more rapid onset of action and a shorter duration of action than regular human insulin
Dosage must be individualized; blood glucose monitoring is essential in all patients receiving insulin therapy
Insulin requirements may be altered during stress, major illness, or with changes in exercise, meal patterns, or coadministered drugs
Humalog U200 not for IV administration
Humalog U-200 with not for mixing with any other insulins
Do NOT perform dose conversion when using either the Humalog U-100 or U-200 KwikPens; the dose window shows number of insulin units to be delivered and no conversion is needed
SC injection
- Do NOT transfer Humalog U-200 from the KwikPen to a syringe for administration; the markings on the insulin syringe will not measure the dose correctly and can result in overdosage and severe hypoglycemia
- Administer within 15 minutes before a meal or immediately after a meal
- When administered by SC injection, insulin lispro should generally be used in regimens with an intermediate- or long-acting insulin
- Administered by SC injection in the abdominal wall, thigh, or upper arm
- Injection sites should be rotated within the same region (abdomen, thigh or upper arm) from one injection to the next to reduce the risk of lipodystrophy
- Humalog U200 not for IV administration
Continuous SC injection (insulin pump)
- May be administered by continuous SC infusion in the abdominal wall
- Do not use diluted or mixed insulins in external insulin pumps
- Infusion sites should be rotated within the same region to reduce the risk of lipodystrophy
- Continuous subcutaneous infusion pump (i.e., insulin pump) not for Humalog U-200 administration; Humalog U-100 only
- Initial programming of the external insulin infusion pump should be based on the total daily insulin dose of the previous regimen
Pediatric dosage forms and strengths
injectable solution
- 100units/mL (10mL vial)
injectable pen
- 100units/mL (3mL pen or cartridge)
- 200units/mL (3mL pen or cartridge)
Type I Diabetes Mellitus
Rapid-acting human insulin analogue indicated to improve glycemic control in adults and children with diabetes mellitus
<3 years: Safety and efficacy not established
≥3 years: May require 0.8-1.2 units/kg/day SC during growth spurts; otherwise, use adult dosing (0.5-1 unit/kg/day)
Dosing Considerations
Approved for use in children aged ≥3 yr for SC daily injections and for SC continuous infusion by external insulin pump
Do NOT perform dose conversion when using either the Humalog U-100 or U-200 KwikPens; the dose window shows number of insulin units to be delivered and no conversion is needed
Humalog U-200 with not for mixing with any other insulins
Dosage of human insulin, which is always expressed in USP units, must be based on the results of blood and urine glucose tests and must be carefully individualized to optimal effect
Continuous SC injection (insulin pump)
- May be administered by continuous SC infusion in the abdominal wall
- Humalog U200 not for IV administration
- Do not use diluted or mixed insulins in external insulin pumps
- Infusion sites should be rotated within the same region to reduce the risk of lipodystrophy
- Initial programming of the external insulin infusion pump should be based on the total daily insulin dose of the previous regimen
- Continuous subcutaneous infusion pump (i.e., insulin pump) not for Humalog U-200 administration; Humalog U-100 only
Humalog, HumaPen Memoir (insulin lispro) adverse (side) effects
Frequency not defined
Hypoglycemia
Pallor
Palpitation
Redness
Hunger
Nausea
Tachycardia
Lipodystrophy
Lipohypertrophy
Local allergic reaction
Hypokalemia
Warnings
Contraindications
During episodes of hypoglycemia
Systemic allergic reactions
Cautions
Never share a pen between patients even if the needle is changed
Adjust dosage and monitoring when medically warranted
Decreased insulin requirements (eg, diarrhea, nausea, vomiting, malabsorption, hypothyroidism, renal impairment, hepatic impairment)
Increased insulin requirements (eg, fever, hyperthyroidism, trauma, infection, surgery)
Hypoglycemia is the most common adverse reaction
May cause a shift in potassium from extracellular to intracellular space, possibly leading to hypokalemia; caution when coadministered with potassium-lowering drugs or conditions that may decrease potassium
Frequent glucose monitoring and insulin dose reduction may be required with renal or hepatic impairment
Do not mix SC injection with insulin preparations other than NPH insulin
Do not mix IV or continuous SC infusions with any other insulins
Do NOT transfer Humalog U-200 from the KwikPen to a syringe for administration; the markings on the insulin syringe will not measure the dose correctly and can result in overdosage and severe hypoglycemia
Do NOT perform dose conversion when using either the Humalog U-100 or U-200 KwikPens; the dose window shows number of insulin units to be delivered and no conversion is needed
Do NOT mix Humalog U-200 with any other insulins
Do NOT administer Humalog U-200 using a continuous subcutaneous infusion pump (i.e., insulin pump); insulin pump is to be used only for Humalog U-100
Do NOT administer Humalog U200 intravenously
Pregnancy
Thiazolidinediones are peroxisome proliferator-activated receptor (PPAR)-gamma agonists and can cause dose-related fluid retention, particularly when used in combination with insulin; fluid retention may lead to or exacerbate heart failure; monitor for signs and symptoms of heart failure, treat accordingly, and consider discontinuing thiazolidinediones
Pregnancy and lactation
Pregnancy category: B
Lactation: Considered safe for use during breastfeeding
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Humalog, HumaPen Memoir (insulin lispro)
Mechanism of action
Protein hormone; stimulates glucose uptake by peripheral cells
Regulates glucose metabolism; insulins lower blood glucose by stimulating peripheral glucose uptake by skeletal muscle and fat and by inhibiting hepatic glucose production. Insulins inhibit lipolysis and proteolysis and enhance protein synthesis; targets include skeletal muscle, liver, and adipose tissue
Absorption
Bioavailability: 55-77% following SC; well absorbed
Onset: 0.5-5 hr (initial); 0.5-2.5 hr
Duration of action: ≤5 hr
Peak plasma time: 0.5-1.5 hr
Distribution
Vd: 0.26-0.36 L/kg
Metabolism
Liver (>50%); kidney (30%); adipose tissue/muscle (20%)
Elimination
Half-life: 1 hr (SC); 0.5-1 hr (IV); dose dependent